Do Medial Pivot Kinematics Correlate With Patient-Reported Outcomes After Total Knee Arthroplasty?

Warth, Lucian C.; Ishmael, Marshall K.; Deckard, Evan R.; Ziemba-Davis, Mary; Meneghini, R. Michael

doi:10.1016/j.arth.2017.03.019

Cited by 44 publications

(37 citation statements)

References 29 publications

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“…Thus, no conclusions can be drawn for other specific TKA designs. However, differently from previous studies where PS and CR designs were pooled together [19,21,23], the investigated cohort of the present study was highly homogenous. This might be considered a strength rather than an issue.…”

Section: Discussionmentioning

confidence: 82%

Over-constrained kinematic of the medial compartment leads to lower clinical outcomes after total knee arthroplasty

Pizza

Paolo

Zinno

et al. 2021

Knee Surg Sports Traumatol Arthrosc

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Purpose To investigate if postoperative clinical outcomes correlate with specific kinematic patterns after total knee arthroplasty (TKA) surgery. The hypothesis was that the group of patients with higher clinical outcomes would have shown postoperative medial pivot kinematics, while the group of patients with lower clinical outcomes would have not. Methods 52 patients undergoing TKA surgery were prospectively evaluated at least a year of follow-up (13.5 ± 6.8 months) through clinical and functional Knee Society Score (KSS), and kinematically through dynamic radiostereometric analysis (RSA) during a sit-to-stand motor task. Patients received posterior-stabilized TKA design. Based on the result of the KSS, patients were divided into two groups: “KSS > 70 group”, patients with a good-to-excellent score (93.1 ± 6.8 points, n = 44); “KSS < 70 group”, patients with a fair-to-poor score (53.3 ± 18.3 points, n = 8). The anteroposterior (AP) low point (lowest femorotibial contact points) translation of medial and lateral femoral compartments was compared through Student’s t test (p < 0.05). Results Low point AP translation of the medial compartment was significantly lower (p < 0.05) than the lateral one in both the KSS > 70 (6.1 mm ± 4.4 mm vs 10.7 mm ± 4.6 mm) and the KSS < 70 groups (2.7 mm ± 3.5 mm vs 11.0 mm ± 5.6 mm). Furthermore, the AP translation of the lateral femoral compartment was not significantly different (p > 0.05) between the two groups, while the AP translation of the medial femoral compartment was significantly higher for the KSS > 70 group (p = 0.0442). Conclusion In the group of patients with a postoperative KSS < 70, the medial compartment translation was almost one-fourth of the lateral one. Surgeons should be aware that an over-constrained kinematic of the medial compartment might lead to lower clinical outcomes. Level of evidence II.

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Section: Discussionmentioning

confidence: 82%

Over-constrained kinematic of the medial compartment leads to lower clinical outcomes after total knee arthroplasty

Pizza

Paolo

Zinno

et al. 2021

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

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“…Recently, Warth et al 23 published an article with different results. It was also aimed to determine whether intraoperative medial pivot kinematic patterns are associated with improved patient outcomes; however, at minimum 1-year FU, Knee Society objective, satisfaction, function, walking pain, stair pain, and the University of California Los Angeles (UCLA) activity level did not differ based on medial vs nonmedial pivot patterns.…”

Section: Discussionmentioning

confidence: 99%

Medial Pivot in Total Knee Arthroplasty: Literature Review and Our First Experience

Sabatini

Risitano

Parisi

et al. 2018

Clin Med�Insights�Arthritis�Musculoskelet Disord

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Background:Traditional total knee implants designs, usually, are not able to reproduce the physiological kinematics of the knee, leaving almost 20% of the patients, those who underwent a total knee arthroplasty (TKA), not fully satisfied. Modern inserts are nowadays designed with a fully congruent medial compartment to reproduce the normal medial pivoting biomechanics of the knee. The aim of this article was to evaluate preliminary clinical improvement using the Medial Congruent (MC) insert as specific level of constraint.Materials and methods:A total of 10 consecutive patients have been enrolled in this study and treated using an MC tibial polyethylene insert. The Oxford Knee Score (OKS) and the Knee Society Score (KSS) have been assessed preoperatively and at 3-month, 6-month, and 1-year follow-up (FU) and used as validated measurements to evaluate early clinical improvements. Postoperative radiological examination was reviewed looking for radiolucent lines or loosening of the components.Results:Average improvement in OKS was from 19.5 to 41.2, whereas KSS improved with an average score from 64.7 preoperatively to 167.5 at the final FU showing good to excellent results in 95% of the treated knees. Evaluating the range of motion, the average maximum active movement was 124° and none of the patients needing for a revision surgery or manipulation under anesthesia. No complications were observed at the final FU as septic or aseptic loosening or vascular or neurologic injury.Discussion and conclusions:Medial Congruent insert showed good to excellent clinical results at 1-year FU. Range of motion and subjective outcomes were satisfying and comparable with results obtained in literature using traditional TKA design.

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“…According to the characteristics of knee kinematics, the medial pivot (MP) prosthesis, which adopts the concept of the "ball-and-socket" design, has been developed. The medial part of the high molecular polyethylene gasket has the shape of a "ball-and-socket" unit, which limits anterior and posterior movement of the medial condyle of the femur, while the lateral condyle can achieve normal back-rolling movement during knee flexion [4,[10][11][12][13]. The MP prosthesis with a single radius of curvature has the advantages of maximizing the ROM of the joint and the contact area between the polyethylene gasket and the femoral prosthesis.…”

Section: Introductionmentioning

confidence: 99%

Comparative study on mid- and long-term clinical effects of medial pivot prosthesis and posterior-stabilized prosthesis after total knee arthroplasty

Shi¹,

Jiang²,

Wang³

et al. 2020

J Orthop Surg Res

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Objective The purpose of this study was to explore the mid-and long-term clinical effects of Chinese patients with medial pivot (MP) prosthesis and posterior-stabilized (PS) prosthesis after total knee arthroplasty (TKA), to provide a reference for the recommendation of clinical prostheses. Methods A retrospective analysis of 802 patients who received TKA was performed from June 2010 to December 2013. A total of 432 patients received a MP prosthesis (MP group) and 375 patients received a PS prosthesis (PS group). Postoperative range of motion (ROM), clinical scores including the knee scoring system (KSS), the Western Ontario and McMaster Universities osteoarthritis index (WOMAC), the forgotten joint score (FJS), and postoperative complications were compared between the two groups. Results A total of 527 patients were followed up, including 290 in the MP group and 237 in the PS group. Both groups achieved satisfactory results in terms of KSS score, WOMAC score, and postoperative ROM, which were significantly improved compared with those before surgery, but the difference between the groups was not statistically significant (P > 0.05). The FJS scores of the MP group and the PS group were satisfactory and no significant difference was observed (P = 0.426). Postoperative complications occurred in 5 and 11 patients in the MP group and PS group, respectively. Conclusion The clinical results of TKA with MP or PS in Chinese patients at mid- and long-term are encouraging, and no significant differences were observed between the two types of prostheses. Studies have also shown that both prostheses are safe for Chinese patients.

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Do Medial Pivot Kinematics Correlate With Patient-Reported Outcomes After Total Knee Arthroplasty?

Abstract: A medial pivot pattern may not significantly govern clinical success after TKA based on intraoperative kinematics and modern outcome measures. Further research is warranted to determine if a particular kinematic pattern promotes optimal clinical outcomes.

Cited by 44 publications

References 29 publications

Over-constrained kinematic of the medial compartment leads to lower clinical outcomes after total knee arthroplasty

Over-constrained kinematic of the medial compartment leads to lower clinical outcomes after total knee arthroplasty

Medial Pivot in Total Knee Arthroplasty: Literature Review and Our First Experience

Comparative study on mid- and long-term clinical effects of medial pivot prosthesis and posterior-stabilized prosthesis after total knee arthroplasty

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